POS0129 TO CONTRAST OR NOT TO CONTRAST? ON THE ROLE OF CONTRAST ENHANCEMENT IN HAND MRI STUDIES OF PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: G. Rübsam, M. Frenken, A. D. Mewes, K. L. Radke, L. Le, L. Wilms, S. Nebelung, D. Abrar, P. Sewerin
Journal: Annals of the Rheumatic Diseases (2022)

Background Currently, clinical indications for application of gadolinium-based contrast agents (GBCA) in magnetic resonance imaging (MRI) are increasingly being questioned 1 . Rheumatoid arthritis is a disease which is characterised by joint inflammation and due to various existing therapies, early diagnosis and sensitive monitoring is beneficial for assessing disease progression, therapy response and optimizing the individual therapy. Objectives This study aimed to evaluate the necessity of contrast enhancement in MRI of the hand in patients with rheumatoid arthritis (RA). Methods 31 patients with RA (mean age, 50±14 years [range, 18–72 years]) from the German ArthroMark cohort underwent morphologic high-field MRI scans on a clinical 3T scanner. MRI studies were analyzed based on (1) the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS 2 ) and (2) the GBCA-free RAMRIS version, termed RAMRIS S ine-G a dolinium- F or- E xperts (RAMRIS-SAFE), in which synovitis and tenosynovitis were assessed using the short-tau-inversion-recovery (STIR) sequence instead of the post-contrast T1-weighted sequence. Results Correlation between RAMRIS and RAMRIS-SAFE in terms of Spearman’s ρ was almost perfect (ρ=0.976; p&lt;0.001). The synovitis subscores, as based on RAMRIS and RAMRIS-SAFE, were equally strongly correlated (ρ=0.937; p&lt;0.001), while the tenosynovitis subscores were less strongly correlated (ρ=0.380 p=0.035). Inter-rater reliability in terms of Cohen’s κ was high (0.963 ≤ κ ≤ 0.925). Conclusion In conclusion, RAMRIS-SAFE as the GBCA-free version of the well-established RAMRIS is a patient-friendly and resource-efficient alternative for assessing disease-related joint changes in RA. As patients with RA are subject to repetitive GBCA applications, non-contrast imaging protocols should be considered. References [1]Olchowy, C.; Cebulski, K.; Lasecki, M.; Chaber, R.; Olchowy, A.; Kalwak, K.; Zaleska-Dorobisz, U. The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review. PLoS One 2017, 12, e0171704, doi:10.1371/journal.pone.0171704. [2]Ostergaard, M.; Peterfy, C.G.; Bird, P.; Gandjbakhch, F.; Glinatsi, D.; Eshed, I.; Haavardsholm, E.A.; Lillegraven, S.; Boyesen, P.; Ejbjerg, B.; et al. The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: Updated Recommendations by the OMERACT MRI in Arthritis Working Group. Journal of Rheumatology 2017, 44, 1706-1712, doi:10.3899/jrheum.161433. Table 1. Composition of both scores: RAMRIS-SAFE and RAMRIS ImagingFeature Anatomic Location MRI Sequence: RAMRIS-SAFE(without contrast enhancement) RAMRIS(with contrastenhancement) Erosion •distal radius and distal ulna coronal T1 coronal T1 •all carpal bones and metacarpal bases •MCP joints (II-V) Osteitis •distal radius and distal ulna coronal STIR coronal STIR •all carpal bones and metacarpal bases •MCP joints (II-V) Synovitis •Distal radio-ulnar joint coronal STIR, coronal and axial •Radiocarpal joint axial T1 T1 + contrast •Intercarpal and carpometacarpal joints •MCP (II-V) joints Tenosynovitis •flexor tendons at the level of MCP joints coronal STIR,axial T1 coronal and axialT1 + contrast Joint spacenarrowing •all radiocarpal, intercarpal, carpometacarpal, . . and MCP joints (n=17) coronal T1 coronal T1 Abbreviations are “RAMRIS” (rheumatoid arthritis MRI scoring system), “RAMRIS-SAFE” (RAMRIS sine gadolinium for experts), “MCP” (metacarpophalangeal), and “STIR” (Short-Tau-Inversion-Recovery). Figure 1. Exemplary imaging features (erosion, osteitis, synovitis, tenosynovitis, and joint space narrowing) that are scored semiquantitatively based on RAMRIS, shown in (i) unenhanced MRT T1-weighted sequence (left column), (ii) STIR sequence (middle column), and enhanced T1-weighted postcontrast sequence (right column). Disclosure of Interests Gesa Rübsam: None declared, Miriam Frenken: None declared, Alexaner Dieter Mewes: None declared, Karl Ludger Radke: None declared, Lien Le: None declared, Lena Wilms: None declared, Sven Nebelung: None declared, Daniel Abrar: None declared, Philipp Sewerin Speakers bureau: AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd./Chugai Europe, Deutscher Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson &amp; Johnson, Lilly/Lilly Europe/Lilly Global, medi-login, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB Pharma, Consultant of: AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd./Chugai Europe, Deutscher Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson &amp; Johnson, Lilly/Lilly Europe/Lilly Global, medilogin, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB, Grant/research support from: Deutsche Forschungsgesellschaft (DFG), Bundesministerium für Bildung und Forschung (BMBF), AMGEN, AbbVie, BMS, Celgene, Chugai, Deutscher Psoriasis-Bund, Janssen-Cilag, Lilly, Novartis, Roche, Rheumazentrum Rhein-Ruhr, UCB Pharma